Treatment for myeloma
Myeloma is treatable, but not yet curable. The aim of treatment is to control the underlying myeloma, relieve symptoms to maximise quality of life, and prolong survival.
The following provides a very brief overview of the main treatment approaches for myeloma and their expected outcomes.
Treatment is covered in greater detail in Module 5 – Treatment for myeloma.
Supportive treatment
At diagnosis many patients present with various symptoms and complications that require immediate supportive treatment even before anti-myeloma treatment is considered.
For example, nurses will be involved in many aspects of care provided to treat patients with hypercalcaemia, pain, anaemia and infection, pathological fractures and spinal cord compression.
These are described in greater detail in Module 8 – Management of disease and treatment-related symptoms and complications in myeloma
Specific anti-myeloma treatment
Nurses caring for myeloma patients should keep up-to-date with the treatment options available. Patients have a right to information about all treatments so that they can make appropriate informed decisions.
There are five main types of treatment for myeloma:
- Conventional chemotherapy agents
- Steroids e.g. dexamethasone, prednisolone
- Targeted agents e.g. proteasome inhibitors, immunomodulatory drugs (IMiDs)
- High-dose therapy and stem cell transplant
- Latest targeted agents e.g. bispecific antibodies, antibody-drug conjugates, next generation iMiDs, CAR-T therapy
The standard approach, both for initial treatment and at relapse, is to combine two or more different types of drugs as most, when used on their own, have limited activity. At least one of the targeted agents is generally combined with a steroid and/or chemotherapy agent. Oral treatment is increasingly favoured over intravenous administration. Radiotherapy is helpful for treating bone pain and plasmacytomas.
For younger and/or fitter patients, high-dose therapy and autologous stem cell transplantat (HDT-SCT) is the treatment of choice following initial (induction) treatment.
HDT-SCT is covered in greater detail in Module 6 – Stem cell transplantation in myeloma.
Where appropriate, the option of taking part in a clinical trial should also be offered to patients.
Most patients will achieve a good response with initial treatment and thereafter can expect to feel well for a period varying from months to upwards of several years without treatment. At some point though, patients will relapse and require further line(s) of treatment.
Further reading
Sive J et al. (2021) Guidelines on the diagnosis, investigation and initial treatment of myeloma: a British Society for Haematology/UK Myeloma Forum Guideline. BJHaem 193,245–268.
Jenner et al (2025) Management of relapsed multiple myeloma: A BSH and UK Myeloma Society guideline. BJHaem 207 (6) 2322-2354.